Global burden and characterization of hypertriglyceridemia-induced acute pancreatitis: results from a systematic review and a multi-center cohort study
Zhengyang Fan, Yuelun Zhang, Jianing Li, Wenhua He, Xiaoyin Bai, Yanna Cai, Naishi Li, Feng Xie, Wen Li, Venkata S. Akshintala, Yin Zhu, Dong Wu
Abstract
To compare and characterize hypertriglyceridemia-induced acute pancreatitis (HTG-AP) across the geographical regions, we conducted a systematic review and a multi-center cohort study. We conducted a systematic review and random effects meta-analysis of studies reporting HTG-AP. Also, we separately characterized HTG-AP in a multi-center retrospective cohort study involving eight centers in China. The key outcomes of interest included the pooled proportion of HTG-AP and its severity parameters after adjusting for the effect of confounding factors through logistic regression. Our systematic review identified 110 studies from 15 countries accounting for 3,057,428 participants (35% female, median age 50 years). The pooled proportion of HTG-AP was 11.6% globally while the Eastern and Western countries reported the proportions as 16.3% and 5.4%, respectively (P<0.01). The pooled mortality rate was remarkably higher in Eastern countries (4.1%) than in Western countries (1.0%) (P<0.01). 3,224 participants (37% female, median age 48 years) were included in our multi-center cohort study, and the proportion of HTG-AP was much higher at 35.9% with a nearly three-fold higher mortality rate compared with acute pancreatitis (AP) due to other etiologies (odds ratio (OR): 2.77, 95% confidence interval (CI): 1.60 to 4.81). The proportion of patients with HTG-AP is remarkably higher in Eastern countries, particularly China, than in Western countries. Furthermore, compared with other causes of AP, HTG-AP has a poorer prognosis and may warrant aggressive management.